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Here in Fukuoka, we welcome many US Veterans not only from within the city but also from areas with US bases such as Sasebo and Iwakuni.
However, the challenge they face is not simply finding an eye clinic where English is spoken.
The real struggle is finding a doctor who not only speaks English but also deeply understands the complex Disability Benefits Questionnaire (DBQ) system and can create these documents with responsibility and precision.
This is the reality many veterans face.
In this article, I would like to explain why I have assumed responsibility for conducting these “Compensation & Pension (C&P) Exams,” which require significant time and advanced expertise, and the mindset with which I approach them.
Language is Just the Tool, Not the Solution
Some might think, “Any English-speaking ophthalmologist can handle this.” However, in practice, language ability is merely a baseline tool.
The documents used for VA Disability Claims are fundamentally different from standard referral letters or medical notes. They are, in essence, legal documents based on the Code of Federal Regulations (CFR).
There are two significant challenges here that differ significantly from daily clinical practice in Japan:
1. The Specificity Required by 38 CFR 4.79
First is the DBQ, which evaluates the current disability.
Eye rating schedules are strictly defined under 38 CFR 4.79. As ophthalmologists, we must describe every finding in accordance with these specific criteria¹.
- Diplopia (Double Vision):
Simply stating “double vision is present” is insufficient. We must accurately record whether it occurs within the central 20 degrees and, if so, in which quadrant (up, down, or lateral), using specific indicators, such as Goldmann perimetry². - Visual Field Defects:
Attaching a standard automated perimetry (Humphrey) result is often not enough. To determine the disability rating, we must report which specific meridians in the central and peripheral fields are affected, providing data that aligns with the VA’s calculation methods³.
2. The “IMO” (Medical Opinion) and Nexus
Even more specialized knowledge is required for the Independent Medical Opinion (IMO).
This involves a medical assessment of whether a current eye condition is related to past military service (establishing a Nexus)⁴.
Using VA-specific definitions, such as “at least as likely as not,” we must develop a logical opinion supported by the medical literature and evidence.
This requires a forensic perspective to link past service records with current symptoms.
Why we Accept This Responsibility
Takeru Eye Clinic has offered services in English since its inception, and treating international patients is part of our daily routine.
英語での診療自体は、日常となっている状態です。
However, the situation with US Veterans is unique.
Many are directed to us through the official VA network, traveling long distances from Sasebo or Iwakuni⁵.
This is because there is a shortage of designated medical facilities that not only speak English but also understand the complex regulations and legal requirements required to responsibly create DBQs and IMOs.
These patients have served their country and now live in Japan, carrying the physical burdens of their long service.
If they are denied access to the benefits they deserve due to language or institutional barriers, I believe that is a form of inequality in healthcare.
Regardless of nationality or background, my goal is to provide appropriate medical evaluations to patients in need. With this in mind, I continue to study and dedicate myself to this work.
Accuracy is Everything
Ambiguity is not permitted in DBQs or IMOs.
Every piece of data and every medical opinion directly impacts the pension and compensation that support a patient’s life.
I have been asked by patients with a desperate look in their eyes: “Doctor, can you write this so my claim gets approved?” My answer is always the same:
“I understand your feelings very well. However, as a physician, I cannot write anything that differs from the facts. Inaccurate descriptions can actually hinder a fair review. Instead, regarding medical facts, I will record them with absolute precision in accordance with VA standards. I will do my absolute best to ensure your legitimate evaluation is not rejected due to paperwork errors.”
This is my integrity and responsibility as a doctor.
Therefore, we spend significantly more time on interviews and examinations than in standard practice to create reports that fully comply with VA guidelines.
A Team Effort
This examination process is not a one-man show.
Precise eye exams—such as Visual Field Tests or detailed refraction—require clear communication between the examiner and the patient.
Doing this in a non-native language and in accordance with US military standards places a tremendous responsibility on the medical staff.
I want to express my deepest gratitude to our Certified Orthoptists (COs) and clinic staff.
Despite the language barrier and the complexity of the protocols, they act with a high level of professional awareness.
They study the necessary technical English, guide patients with patience, and ensure the data we collect is accurate.
Takeru Eye Clinic serves the veteran community only through our daily dedication and teamwork.
To Veterans in Fukuoka
Our clinic is conveniently located between Nishijin and Fujisaki stations in Sawara Ward, with easy subway access.
If you are a US Veteran, a family member, or a medical coordinator reading this, please know one thing:
We are not just “English-capable.” We are a medical institution ready to “work as a team to faithfully and accurately complete the documents (DBQ/IMO) that affect your career and life.”
This work requires time, expertise, and a high level of staff commitment. It is not something we take lightly.
As medical professionals, we are committed to fulfilling this role quietly but surely.
References
- Electronic Code of Federal Regulations (eCFR). 38 CFR 4.79 — Schedule of ratings—eye.
https://www.ecfr.gov/current/title-38/chapter-I/part-4/subpart-B/subject-group-ECFRaef02c2cebadb31/section-4.79 - Veterans Benefits Knowledge Base. Rating Schedule for The Eyes.
https://www.veteransbenefitskb.com/eyes - Office of Information and Regulatory Affairs. EYE CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE.
https://www.reginfo.gov/public/do/DownloadDocument?objectID=23454001 - Veterans Benefits Administration. Public Disability Benefits Questionnaires (DBQs).
https://www.benefits.va.gov/compensation/dbq_publicdbqs.asp - Department of Veterans Affairs. Claims Process and Compensation and Pension Exams by Contracted Physicians. Congress.gov.
https://www.congress.gov/crs_external_products/R/PDF/R47163/R47163.9.pdf - Department of Veterans Affairs. VA Claim Exam (C&P Exam).
https://www.va.gov/resources/va-claim-exam/
Disclaimer: This article provides information on medical evaluations (DBQ/IMO) from the perspective of an ophthalmologist. The final decision regarding disability ratings and benefits lies solely with the U.S. Department of Veterans Affairs (VA). Takeru Eye Clinic does not guarantee specific outcomes or ratings.
Disclaimer: This article provides information on medical evaluations (DBQ/IMO) from the perspective of an ophthalmologist. The final decision regarding disability ratings and benefits lies solely with the U.S. Department of Veterans Affairs (VA). Takeru Eye Clinic does not guarantee specific outcomes or ratings.
